Mortality in vegetarians and comparable nonvegetarians in the
United Kingdom 2016

Paul N Appleby, Francesca L Crowe, Kathryn E Bradbury, Ruth C Travis, and Timothy J Key*
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom

ABSTRACT
Background: Vegetarians and others who do not eat meat have been
observed to have lower incidence rates than meat eaters of some chronic
diseases, but it is unclear whether this translates into lower mortality.

Objective: The purpose of this study was to describe mortality in
vegetarians and comparable nonvegetarians in a large United Kingdom cohort.

Design: The study involved a pooled analysis of data from 2 prospective studies that included 60,310 persons living in the United Kingdom, comprising 18,431 regular meat eaters (who ate meat
$5 times/wk on average), 13,039 low (less-frequent) meat eaters,
8516 fish eaters (who ate fish but not meat), and 20,324 vegetarians
(including 2228 vegans who did not eat any animal foods).

Mortality by diet group for each of 18 common causes of death was estimated
with the use of Cox proportional hazards models.

Results: There were 5294 deaths before age 90 in .1 million y of
follow-up. There was no significant difference in overall (all-cause)
mortality between the diet groups: HRs in low meat eaters, fish
eaters, and vegetarians compared with regular meat eaters were
0.93 (95% CI: 0.86, 1.00), 0.96 (95% CI: 0.86, 1.06), and 1.02
(95% CI: 0.94, 1.10), respectively; P-heterogeneity of risks =
0.082.

There were significant differences in risk compared with
regular meat eaters for deaths from circulatory disease [higher in
fish eaters (HR: 1.22; 95% CI: 1.02, 1.46)]; malignant cancer [lower
in fish eaters (HR: 0.82; 95% CI: 0.70, 0.97)], including pancreatic
cancer [lower in low meat eaters and vegetarians (HR: 0.55; 95%
CI: 0.36, 0.86 and HR: 0.48; 95% CI: 0.28, 0.82, respectively)] and
cancers of the lymphatic/hematopoietic tissue [lower in vegetarians
(HR: 0.50; 95% CI: 0.32, 0.79)]; respiratory disease [lower in low
meat eaters (HR: 0.70; 95% CI: 0.53, 0.92)]; and all other causes
[lower in low meat eaters (HR: 0.74; 95% CI: 0.56, 0.99)]. Further
adjustment for body mass index left these associations largely
unchanged.

Conclusions: United Kingdom–based vegetarians and comparable
nonvegetarians have similar all-cause mortality. Differences found
for specific causes of death merit further investigation. Am J
Clin Nutr 2016;103:218–30

BMJ 20 May 2023 Adapted from Letter of the Week by Ellen Fallows, British Society of Lifestyle Medicine

Changing the mindset in medicine

Clinicians are often overwhelmed when they see patients with many complex conditions who have brought both physical and social problems to a long awaited but short consultation.

When medical guidelines are viewed in totality, it is clear that we can’t see the wood for the trees, have forgotten the person behind the disease, and are failing to tackle the root cause of their symptoms.

Basic science now describes a common underlying pathology to long term conditions: immune dysregulation resulting in chronic systemic inflammation. Key drivers include environmental and lifestyle factors influencing gene expression and our microbiome.

Our current medical model is however based on a reductionist and deterministic view of health that stems from the era of gene discoveries. This has led to a belief that diseases exist in isolation and we are powerless without medicine and drugs. This is not the case. If we step back from the relentless assessment, quantification, and labelling of disease and spend more time tackling its root causes, we can support people to reverse- or at least improve or delay-these conditions.

Fewer guidelines and assessments are needed, as well as more public health measures and more lifestyle medicine. Lifestyle medicine is a discipline that considers the socioeconomic drivers of behaviour, acknowledges the difficulties people face, and uses person centred techniques to support lifestyle changes to tackle nutrition, physical activity, social isolation, sleep, mental wellbeing, and consumption of harmful substances such as tobacco and alcohol.

This approach isn’t new or controversial- it is the first step in all major long term condition guidelines. But it is neglected, with funds for creating good quality education and an evidence base sorely lacking and requiring a policy shift.

The hardest behaviour to change however, is not that of patients but that within medicine itself.

My comment: I am so much in agreement with this letter. It was impressive that the BMJ published it so prominently.

Adapted from Human Givens Volume 30 No 1 2023

Psychological Reports 2023 doi:10.1177/00332941231161794.

Psychologists report that having more daily “uplifts” in a person’s life can reduce their tendency to eat junk food snacks.

The uplifts seem to act as a buffer against emotional eating. Emotional eating episodes, daily hassles and daily uplifts were recorded by 160 participants in this study over 24 hours.

The more hassles experienced the more snacking occurred. However the snacking became far less when people experienced higher levels of daily uplifts compared to moderate or low levels of daily uplifts.

My comment: Some examples of daily hassles include: getting out of bed late, not getting a good sleep, no milk/food in the fridge, trouble deciding what to wear, tripping over the dog, de-icing the car, being cut up in traffic, a long or troublesome commute, stepping on dog mess, no change for the parking meter, phone not charged, can’t find the other glove, missing the bus, having to stand on the bus, trouble logging onto the computer, computer not working, extra work being dumped on you, interruptions at work, being unwell or having a spot on your face, someone being rude to you, getting the Wordle word wrong, forgetting your packed lunch, a long wait for lunch, having to contribute to a lift at work or sponsored event, unexpected meetings, meetings over running, just having meetings, getting out of work late, having to arrange personal stuff during work without other people knowing about it, having to wait in for a delivery or workman, bad weather, house being a mess, noisy neighbours or flatmates, run out of hot water for a bath or shower, not getting to bed on time. I had no trouble coming up with this list!

So what uplifts can happen or can you plan to happen? You will need to do a considerable amount of forward planning and organisation and prioritisation so that the daily hassles that you can control don’t control you. You can go to bed earlier so you get a good sleep, but you can’t spend the time you may otherwise wish to on work, socialisation or watching the television. You can decide on your outfit the night before and make your packed lunch and shop appropriately the day before. You can have a house rota for hot water use and strictly enforce protected food in the fridge. You can also eliminate junk food in the house. This is less easy in the workplace. Be realistic how long it takes to get from A to B and perform daily tasks.

You can pet your cat or dog in the morning instead of reading the news or going on social media. You can wear clothes that are bright colours instead of grey and black. Do you have nice houseplants in your home and office? Do you wear a nice perfume? You can put on make up that can quickly make you look better but you need to simplify your routine so it doesn’t take up valuable time. You can smile and speak to people you meet. You can get up regularly at work so that you aren’t sitting for long periods. You can make a point of taking the breaks that you need and deserve. Do you have to attend every meeting? If you are chairing a meeting can you be ruthless about who really needs to attend? Can you start promptly and finish within 30 minutes?

Can you have a personal chat instead of an e mail or phone call? Can you get out during the day? Can you leave on time? Can you give a sincere complement to someone or help out a colleague? Can you politely decline to do work that isn’t yours to do? Can you fit in some time in nature or exercising to decompress between work and home?

I think a lot of reason for stress at work and in the home is the feeling or actuality of not being in control. This leads to inner pressure which is relieved to some extent by emotional eating. Have a think about what you can do to make life easier for yourself.

Adapted from Scientific Reports 2022 doi:10.1038/s41598-022-24053-4 and BMJ 3 June 23 and BMJ 1 Jul 23.

A USA retrospective study on veterans found that vitamin D supplementation reduced Covid infection by 20-28% and mortality rates by 25-33%.

Black veterans got more benefit than white veterans, possibly because darker skins absorb less vitamin D from the sun.

Vitamin D3 supplementation was more effective than Vitamin D2 supplementation.

Covid infection has been shown in a Danish study to have no impact on the later appearance of Type One Diabetes.

During the pandemic 90% of Danish children were tested for Covid, often on multiple occasions. There was no increase in type one diabetes in the children who had been infected compared to those who tested negative throughout.

Covid infection, meanwhile, has not yet settled into a seasonal pattern like influenza. Most countries are seeing more frequent but less severe infections than during the pandemic. This is due to the speed of mutation of the spike protein which is evolving twice as fast as the usual influenza viruses and ten times faster than seasonal coronaviruses that cause runny noses, coughs and sore throats.

Metformin users can feel pleased that yet another advantage to taking the drug has been found. If taken during the acute phase of Covid infection, Metformin led to 40% fewer cases of long Covid over a ten month period. Metformin was given within 3 days of a positive Covid test and was continued for two weeks. This was a placebo controlled trial.

Vitamin D supplementation in a double blinded randomised controlled study from 2014 to 2020 in Australia was found to reduce the risk of major cardiovascular events.

Over 21 thousand participants aged 60-84 years of age were randomly assigned to have monthly oral doses of Vitamin D3 60,000 IU or a placebo for five years. The researchers then measured how many heart attacks, strokes, and coronary revascularisation procedures occurred.

A reduction in cardiac and revascularisation events was most clearly seen in those participants who were taking the vitamin D and particularly in those were already on drugs for the cardiovascular system at the start of the study. The number needed to treat to avoid an event was one in 172. There was no difference in the number of strokes between the groups.

ORIGINAL RESEARCH & CONTRIBUTIONS

Statin-Associated Cardiomyopathy Responds to Statin Withdrawal and Administration of Coenzyme Q10

Peter H Langsjoen, MD, FACC1 ; Jens O Langsjoen, MD2 ; Alena M Langsjoen, MS1 ; Franklin Rosenfeldt, MD, FRACS3,4 Perm J 2019;23:18.257 E-pub: 08/26/2019 https://doi.org/10.7812/TPP/18.257

ABSTRACT Context: Heart failure (HF) is rapidly increasing in incidence and is often present in patients receiving long-term statin therapy.

Objective: To test whether or not patients with HF on long-term statin therapy respond to discontinuation of statin therapy and initiation of coenzyme Q10 (CoQ10) supplementation.

Design: We prospectively identified patients receiving long-term statin therapy in whom HF developed in the absence of any identifiable cause. Treatment consisted of simultaneous statin therapy discontinuation and CoQ10 supplementation (average dosage = 300 mg/d).

Main Outcome Measures: Baseline and follow-up physical examination findings, symptom scores, echocardiograms, and plasma CoQ10 and cholesterol levels.

Results: Of 142 identified patients with HF, 94% presented with preserved ejection fraction (EF) and 6% presented with reduced EF (< 50%). After a mean follow-up of 2.8 years, New York Heart Association class 1 increased from 8% to 79% (p < 0.0001). In patients with preserved EF, 34% had normalization of diastolic function and 25% showed improvement (p < 0.0001).

In patients with reduced EF at baseline, the EF improved from a mean of 35% to 47% (p = 0.02).

Statin-attributable symptoms including fatigue, muscle weakness, myalgias, memory loss, and peripheral neuropathy improved (p < 0.01).

The 1-year mortality was 0%, and the 3-year mortality was 3%.

Conclusion: In patients receiving long-term statin therapy, statin-associated cardiomyopathy may develop that responds safely to statin treatment discontinuation and CoQ10 supplementation

My comment: Apparently the administration of Co-enzyme Q10 on its own without statin discontinuation rarely works to restore cardiac function on its own in heart failure patients. This is discussed in the article. Co-enzyme Q10 is also helpful for gum disease which affects people with diabetes a lot.

Diabetes in Control

Occupational Consequences in Type 1 Diabetes

According to research presented by Dr. Andrea Dehn-Hindenberg from the Hannover Medical School in Germany, mothers in children with diabetes experience many challenges in their occupational settings.

 Diabetes is a persistent condition that requires regular maintenance to limit adverse consequences.

When a child is diagnosed with diabetes, self-management of the disease is often unimaginable. Therefore, the management of the condition is conducted by the guardians of those children.

Although treatment options are vast and full of new advancements, the treatment of children is a tedious and trying task for caretakers. They are frequently entrusted with giving diabetes treatment consistently while giving proper nurturing and support to the remainder of the family. They also end up adjusting their day-to-day life and their occupational demands.

Family psychosocial factors have been shown to influence diabetes results in kids. As a result, diabetes treatment should incorporate the entire family and consolidate their efforts and difficulties in their professional and daily lives to accomplish the best treatment results for those children with diabetes.

This trial sought to investigate parents’ work-related and financial issues following their children’s onset of type 1 diabetes. This study aimed to highlight the burdens that come from type 1 diabetes on families and provide the necessary information to technology developers and policymakers to improve the quality of life of these individuals.

Dr. Dehn-Hindenberg and her colleagues submitted this research to the Journal of Diabetes Care to examine and summarize the benefits in this patient population.

Participants in this study included mothers, fathers, and primary caregivers of adolescents with type 1 diabetes. The questionnaire involved occupational and financial components of caregivers from their child’s diagnosis of diabetes. It included both parents’ job status, professional engagement activities, and financial loss from the diagnosis.

A total of 1192 participants agreed to complete the questionnaire. However, 1144 participants were included in the final sample. 82% of the respondents in the questionnaire were mothers. The mean age of children was 6.7 years old, and the duration of diabetes was 5.9 years. At the time of the survey, 62.5% were aged six to ten, while 45% were 11 to 14.

Before the diagnosis of diabetes in their children, 22.8% of mothers worked full time. Among these mothers, 15.1% of them stopped working after their child was diagnosed. 91% of fathers worked full time before and after the diagnosis occurred in their children. Parents also reported constraints on their professional development. 50.7% of mothers said they were negatively impacted due to their child’s diabetes. 95.9% of fathers reported no change in their professional development. According to the results, a moderate to significant financial burden was reported in 46.4% of families: the younger the child, the more severe the financial obligation.

In conclusion, more studies should be done to evaluate the vast components of taking care of adolescents with type one diabetes. This study helps to give more information on complications that can affect those in this patient population. According to Dr. Dehn-Hindenberg, “the findings demonstrate that mothers, rather than fathers, compromised their occupational success to provide care for their children with diabetes.”

References

Dehn-Hindenberg, Andrea, et al. “Long-Term Occupational Consequences for Families of Children with Type 1 Diabetes: The Mothers Take the Burden.” Diabetes Care, vol. 44, no. 12, 2021, pp. 2656–2663., link

Sundberg, Frida, et al. “Managing diabetes in preschool children.” (2017). link

Iversen, Anne Solveig, et al. “Being mothers and fathers of a child with type 1 diabetes aged 1 to 7 years: a phenomenological study of parents’ experiences.” International journal of qualitative studies on health and well-being 13.1 (2018): 1487758. link

Kmeone Kingdom, MPH, PharmD Candidate, South College School of Pharmacy

ORIGINAL RESEARCH article

Front. Nutr., 07 March 2022
Sec. Nutritional Epidemiology
Volume 9 – 2022 | https://doi.org/10.3389/fnut.2022.806566

Priority Micronutrient Density in Foods

Ty Beal^1,2* and Flaminia Ortenzi³

• ¹Knowledge Leadership, Global Alliance for Improved Nutrition, Washington, DC, United States
• ²Department of Environmental Science and Policy, University of California, Davis, Davis, CA, United States
• ³Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland

Background: Despite concerted efforts to improve diet quality and reduce malnutrition, micronutrient deficiencies remain widespread globally, especially in low- and middle-income countries and among population groups with increased needs, where diets are often inadequate in iron, zinc, folate, vitamin A, calcium, and vitamin B₁₂. There is a need to understand the density of these micronutrients and their bioavailability across diverse foods and the suitability of these foods to help meet requirements for populations with high burdens of micronutrient malnutrition.

Objective: We aimed to identify the top food sources of these commonly lacking micronutrients, which are essential for optimal health, to support efforts to reduce micronutrient malnutrition among various populations globally.

Methods: We built an aggregated global food composition database and calculated recommended nutrient intakes for five population groups with varying requirements. An approach was developed to rate foods according to their density in each and all priority micronutrients for various population groups with different nutrient requirements.

Results: We find that the top sources of priority micronutrients are organs, small fish, dark green leafy vegetables, bivalves, crustaceans, goat, beef, eggs, milk, canned fish with bones, mutton, and lamb. Cheese, goat milk, and pork are also good sources, and to a lesser extent, yogurt, fresh fish, pulses, teff, and canned fish without bones.

Conclusion: The results provide insight into which foods to prioritize to fill common micronutrient gaps and reduce undernutrition.

My comment: There has been a recent rise in nutritional deficiency diseases in the UK in both adults and children. Organ meats, tinned sardines, dark green leafy vegetables, eggs, milk, pork and pulses are good value for money foods that could help.

Adapted from BMJ 15 July 2023

Northern Ireland and Scotland have already instituted eye screening every two years for diabetic patients who are thought to be at low risk of eye complications.

Wales are now adopting this screening interval as well and England will follow suit from this coming October.